While Patient Blood Management (PBM) is becoming a new standard worldwide with evidence-based and expert consensus guidelines to promote the three PBM pillars, measuring the performance of these efforts remains a challenge. PBM programmes need to measure transfusion reductions and patient-specific outcomes, and report these to drive change.
Here is one such impactful report supporting the feasibility and associated transfusion reductions of a PBM programme. This is an interesting retrospective quality improvement report from Dr. Spahn and co-authors of the University Hospital of Zurich who investigated the impact of their PBM programme on blood transfusion practices, costs and sustainability. Blood transfusion practices for each department were monitored and feedback was provided on a regular basis regarding adherence to set transfusion thresholds based on a Hb <9 g/dL, platelet count <100 G/L and PT >12.7 or Factor V activity <20%.
The authors included over 200 000 patients; about 60 000 from the pre-PBM programme year (2012-13) as a baseline, 44 000 from year one of the PBM programme (2014) and over 110 000 from the time period 2015-17. The feasibility, sustainability and associated decreased allogeneic blood transfusion (by 35%) with a corresponding reduction in costs is reported.
The fact that the authors did not find a change in in-hospital mortality and did not include an analysis of any adverse outcomes are limitations in part due to the retrospective nature of the report. Prospective well-designed multicentre studies with patient-centred outcome measures are needed to drive this message home – PBM programmes improve care, decrease complications and decrease costs.
– Susan M. Goobie (SABM reviewer)